By April 23, 2026: (1) Billing team must update Aetna authorization and claims processing system to implement strict coverage criteria for ketogenic diet hospitalization—APPROVE only for pediatric patients (under 18) with intractable seizures who meet all selection criteria (failed adequate anti-convulsant trial ≥1 year, family compliance support, outpatient unsafe), and patients with glucose transporter protein type 1 deficiency (E88.09) or pyruvate dehydrogenase complex deficiency (E74.4). (2) Configure system to DENY claims for all other indications including adult epilepsy (G40.001, G40.011, G40.101, G40.111, G40.201, G40.211, G40.301, G40.311, G40.A01, G40.A11, G40.B01, G40.B11, G40.401, G40.411, G40.501, G40.801, G40.803, G40.821, G40.823, G40.901, G40.911), autism spectrum disorder, cancer, Alzheimer's disease, migraine, mood disorders, multiple sclerosis, Parkinson's disease, schizophrenia, spinal cord injury, Type 2 diabetes, and Prader-Willi syndrome weight management. (3) Create prior authorization template requiring documentation of: anti-convulsant medication trial history (specific drugs, dosages, duration ≥1 year, compliance), member age confirmation (must be <18), family/caregiver commitment statement, and explanation of why outpatient setting is unsafe. (4) Notify providers and medical directors of new restrictions. (5) Flag all historical ketogenic diet hospitalizations for adult patients and psychiatric indications for claim review/potential recovery. Failure to implement will result in inappropriate claim payments and compliance violations.